tbuckley/cabot-search huggingface dataset:
Abstract 10770: Effects of Glucagon-Like Peptide-1 Receptor Agonists on Patients With or Without Heart Failure: A Meta-Analysis of Randomized Control Trials
Authors: SHOTA OBATA, Yoshihisa Miyamoto, Leandro Slipczuk, Hisato Takagi, Toshiki Kuno
Journal: Circulation (2022)

Background: Glucagon-like peptide-1 receptor agonists (GLP -1RAs) reduce the risk of a major adverse cardiovascular event (MACE) and heart failure (HF) in patients with type 2 diabetes mellitus (T2DM). However, these outcomes are not similarly demonstrated in those with HF in subgroup analyses of several randomized controlled trials (RCTs). We evaluated the effect of GLP-1RAs on MACE and HF admissions for T2DM patients with the previous history of HF. Methods: We searched PubMed and EMBASE through March 2022 to identify RCTs examining the effects of GLP-1RAs compared to placebo on MACE and HF admission in T2DM patients with a history of HF. MACE was mainly defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke. We performed a meta-analysis with random effects model. Results: Our analysis included subgroup analyses of 7 RCTs enrolling a total of 8,965 patients with T2DM and history of HF. Pooled analysis demonstrated a significant decreased MACE (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.78-0.99; P = 0.039; I2 = 18.1%) in the GLP-1RAs group (Figure 1A). In contrast, the rate of HF admission was not significantly different between the both groups (HR, 1.03; 95% CI, 0.91-1.16; P = 0.67; I2 = 0.0%) (Figure 1B). Conclusions: GLP-1RAs significantly reduced MACE in patients with HF and T2DM compared to the placebo group but did not affect the risk of HF admission in both groups.
Abstract 10884: X-Linked Genetic Associations in Sporadic Thoracic Aortic Aneurysm and Dissection
Authors: Fadi I Musfee, Goo Jun, Laura E Mitchell, Han Chen, Dongchuan Guo, Megan L Grove, Eric Boerwinkle, Dianna M Milewicz
Journal: Circulation (2022)

Introduction: The male predominance in sporadic thoracic aortic aneurysm and dissection (TAD) and the high prevalence of TAD in Turner syndrome patients suggest the contribution of X chromosome genes to TAD. However, such role has not been explored. Methods: We investigated whether X-linked variation, both common (Minor Allele Frequency (MAF) ≥0.01) and rare (MAF &lt;0.01), was associated with sporadic TAD in three datasets of European descent (dataset-1: 753 cases, 2247 controls; dataset-2: 253 cases, 282 controls; dataset-3: 364 cases, 874 controls). All cases were obtained from McGovern School of Medicine and Baylor College of Medicine; however, controls were obtained from the Atherosclerosis Risk in Communities study (dataset-1), the University of Washington Center for Mendelian Genomics (dataset-2), and the National Institute of Neurological Disorders and Stroke Repository (dataset-3). We applied a sex-stratified logistic regression model, followed by a meta-analysis of sex specific odds ratios for common variants, and an optimized sequence kernel association test model for rare variants. For top (P≤1x10 -3 ) common X-linked variants from the three datasets, we performed tissue enrichment analysis using a hypergeometric test. Results: The majority of cases (75%) were males. In dataset-2, common variant, rs55936630, in IGSF1 (P meta-analysis: 2.43x10 -7 ), reached X chromosome-wide significance. An additional 125 variants were suggestive of an association (P meta-analysis ≤1x10 -3 ) in at least one of the three datasets. Tissue enrichment identified a set of 12 X-linked genes that was significantly enriched in blood vessels (P: 3x10 -2 ). RTL9 (P: 5.15x10 -5 ; dataset-1) reached X chromosome-wide significance in rare variants analyses. Conclusions: This is the most comprehensive X-chromosome association analysis of TAD to date. Although most of our common variants did not reach X chromosome-wide significance, collectively testing these variants in tissue enrichment analysis identified a set of 12 X-linked genes that was significantly enriched in blood vessels. Among these 12 X-linked genes were C1GALT1C1 and DMD which were previously associated with vasculitis and arterial stiffness, respectively, both of which are risk factors for TAD.
Abstract 10262: High Output Cardiac Failure Due to Kratom
Authors: Mohammad Gareeb, Chetan Bhardwaj, Padmaraj D Duvvuri
Journal: Circulation (2022)

Introduction: Kratom use has been known to the natives of Malaysia to increase energy and to treat pain. Over the recent past there has been an increase in Kratom usage in the U.S. with the ease of access. Case Summary: A 24-year-old male presented to the emergency department due to progressive shortness of breath and pedal edema over one month. The patient reported a history of daily Kratom use for the past 2 years. His vitals upon presentation were BP: 90/50 mmHg, HR 101 bpm, O2 saturation 100% and was afebrile. Relevant abnormal labs were: sodium 114 mEq, and a BNP of 2,747 pg/mL. Other labs including TSH and urine drug screen were unremarkable. Initial ECG showed normal sinus rhythm, right axis deviation and QTc of 552 ms. Chest X ray revealed a prominent pulmonary conus. After being admitted to the ICU, he had an appropriate gradual increase in sodium level over the next 4 days. The transthoracic echocardiogram showed an LVEF of 70-75% and multiple findings suggestive of severe pulmonary hypertension and severe tricuspid regurgitation (Fig. 1 parts A and B). His estimated PASP was 95 mm Hg. Right heart catheterization demonstrated the following pressures (in mmHg): RA 5/6, PA 52/26 (37), mean PCWP 7. Cardiac output and index were 8.9 L/min and 5 L/min/m2 by Fick, 7.7 L/min and 4.3 L/min/m2 by thermodilution. Four weeks after cessation of Kratom use he underwent a transthoracic echocardiogram which showed complete normalization of abnormal findings shown in Fig. 1 parts C and D. His RVSP normalized to 26 mm Hg. Conclusion: Previously reported adverse cardiovascular events from Kratom use include tachycardia, hypertension, chest pain, conduction defects, QTc prolongation as well as cardiac arrest. We present previously unknown complications of Kratom use, namely combined pre and post capillary pulmonary hypertension and high output heart failure.
Abstract 10200: Costs and Resource Utilization of People With Stable Heart Failure and Insomnia: Evidence From a Randomized Trial
Authors: Christopher S Hollenbeak, Sangchoon Jeong, Meghan O'Connell, Nancy S Redeker, Henry Yaggi
Journal: Circulation (2022)

Introduction: Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating insomnia in the presence of comorbid conditions. This study estimated healthcare costs and resource utilization for people with stable chronic HF and insomnia using data from an NIH-funded clinical trial comparing CBT-I with an HF self-management Methods: Using data from the HeartSleep Study, we examined resource utilization one year following randomization. Resource utilization was measured as self-reported physician office visits, emergency department visits, and inpatient admissions, collected at each follow-up. Costs were estimated by applying price weights to visits, and adding self-reported out of pocket expenses and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and attention control groups. A generalized linear model (GLM) was used to model costs, controlling for covariates. Results: There were no significant differences in demographic characteristics between patients who received CBT-I (N=79) and those who received HF self-management (attention control) (N=71). During the first year following randomization, participants receiving CBT-I had 4.2 inpatient hospitalizations compared to 4.6 for the attention control group (p = 0.40). Participants receiving CBT-I also had 13.1 outpatient visits on average, while control participants had 15.4 outpatient visits. Relatively few emergency department visits were required by either CBT-I or attention-control participants. Overall, total costs were slightly higher for participants who received CBT-I ($7,813 vs. $7,538, p = 0.96). In the multivariable analysis participants who received CBT-I had $630 in higher costs, but this was not statistically different from the attention control group. Conclusions: Among patients with both HF and insomnia, CBT-I and HF self-management had similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to other treatments for insomnia in patients with HF.
Abstract 10734: Percutaneous Closure of Aorto-Right Atrial Fistula: An Interesting Case of Marfan’s Syndrome and Fistula Formation
Authors: Ahmed Mahmood, Vivek Nadipalli, Muhammad Uzair Lodhi, Bilal Hussain, Carlos E Vargas, Sohail Khan, christel cuevas, Thomas Alexander
Journal: Circulation (2022)

Case Presentation: A 43-year-old male with a history of Marfan’s syndrome, coronary artery disease and mitral valve endocarditis status-post mitral valve annuloplasty was admitted with NYHA class IV symptoms and cardiogenic shock. Two distinct color-flow jets on transesophageal echocardiography (TEE) supported evidence for fistulae formation at the aortic sinus and the right atrium (RA). After stabilization, closure options were discussed with the patient and a multi-disciplinary team including a cardiothoracic surgeon, structural heart disease specialist and heart failure specialist. Shared decision for percutaneous closure of the fistula was made. Figure 1A, demonstrates a peri-operative TEE with two distinct fistulae with color-flow jets emanating from the sinus of Valsalva into the RA. Each fistula orifice measured approximately 3mm in diameter with 5mm of separation. Under fluoroscopy, trans-aortic wire and sheath were used to cross a single fistula into the RA. An 18mm occluder device (Figure 1B and 1C), was deployed via transaortic into the RA. Intracardiac echocardiography revealed good device position and trivial jet. Post-operative TEE verified successful occlusion of both fistula. The patient tolerated the procedure and was discharged. He was seen in clinic two weeks post-discharge and reported resolution of his dyspnea. Conclusion: Aorto-atrial fistulas (AAF) are rare, complex and life-threatening; however, potentially treatable conditions. While most cases are acquired, congenital causes exist. This is an interesting case that illustrates a unique presentation of a rare condition and showcases potential for endovascular treatment. There are no randomized clinical trials and more scientific evidence is required to establish recommendations for a diagnostic and treatment algorithm. Until then clinical judgment with consideration for percutaneous closure seems a viable option.
Abstract 10310: Sudden Cardiac Death in Recently Diagnosed Patients With Light-Chain Cardiac Amyloidosis
Authors: Mason Marcus, Lori Roth, Aishwarya Sannareddy, Gurbakhash Kaur, Larry D Anderson, Justin L Grodin, Mark S Link
Journal: Circulation (2022)

Introduction: Untreated, light-chain (AL) cardiac amyloidosis is associated with a median survival of 6-months when diagnosed in advanced stage. However, current plasma cell-targeting therapies have drastically improved end-organ function and life expectancy. Yet, a portion still die despite appropriate treatment. We hypothesize this is from sudden cardiac death (SCD). Aim: To determine the incidence of and clinical characteristics associated with 90-day SCD after diagnosis of AL amyloidosis. Methods: Clinical, electrocardiographic, imaging, treatment, and outcomes were abstracted from consecutive patients diagnosed with AL amyloidosis from 2014-2022 at UT Southwestern Medical Center. Statistics were reported as mean and standard deviation. Results: In our study cohort (N=189) patients with AL amyloidosis, 18 patients (66% male, age 65 ± 9.5 y) died by 90-days (9.5%). Of these, 14 patients died by 60-days (7.3%), and 10 patient died by 30-days (5.2%). There were 7 cardiac deaths (3.6%): including one PEA arrest (0.5%), one in-hospital cardiac arrest (0.5%) and five unwitnessed out-of-hospital cardiac arrests (2.6%). Among cardiac deaths, 3 patients had endomyocardial tissue consistent with AL. Revised Mayo Stage was 66% III, 33% IV. Six patients had at least one dose of chemotherapy with bortezomib, cyclophosphamide and dexamethasone (CyBorD), Velcade/Dexamethasone, or Daratumumab/CyBorD, and 5 had at least one full cycle. The LVEF was 48.9 ± 8.1, QTc 483 ± 50 ms, interventricular septal thickness was 1.2 cm ± 0.4 cm. CMR was obtained in 4 of 7 patients, with late gadolinium enhancement present in a diffuse pattern in 75%, average LVEDV 59 ± 9.5 mL. Mean time to death was 37.2 ± 21 days. Conclusions: Sudden cardiac death may be a significant contributor to mortality among patients with newly diagnosed AL amyloidosis. These observations warrant confirmation in larger cohorts and may identify an unmet need to enhance risk stratification for SCD in this population.
Abstract 10481: The Effect of Current Smoking on Platelet Reactivity Measures by Point-of-Care Methods in Patients Treated With and Without Clopidogrel
Authors: Jose C Nicolau, Rocio Salsoso, Talia Dalcoquio, Paul A Gurbel, Udaya Tantry, Robert Giugliano, Carlos A Nakashima, Andre Franci, Paulo Rizzo, fernando menezes, Bruno Guardieiro, Marco Antonio Scanavini Filho, Aline G Ferrari, Cesar Pereira, Flavia B Arantes, Carlos Barbosa, Adriadne Bertolin, Remo Furtado
Journal: Circulation (2022)

Introduction: Smoking is associated with worse response to P2Y12 inhibitors. However, the relationship between smoking, platelet reactivity (PR) and traditional risk factors for atherosclerosis is unclear. Hypothesis: To analyze the relationship between smoking, PR and risk factors for atherosclerosis. Methods: A prospective databank of 13 research protocols was retrospectively analyzed. Among 1260 patients included in the analysis, 299 were smokers; 721 had acute coronary syndromes (521 with clopidogrel), and 539 had stable coronary artery disease (4 with clopidogrel). The association between smoking and PR analyzed by Multiplate-ADP (MPADP) and VerifyNow-PRUTest (VNPRU), inflammatory markers (leukocytes and hs-C-reactive protein), creatinine, HbA1c, total cholesterol, HDL-c, LDL-c and triglycerides, was analyzed in univariate and multivariable models. PR results were analyzed as continuous and categorical variables (bellow or above the median). Results: Unadjusted results for the comparison between smokers and non-smokers are depicted in the Table and Figure. In adjusted models, the significant associations between smoking and PR were maintained: 1) MPADP Odds-Ratio (OR)=0.984, p&lt;0.001; 2) VNPRU OR=0.996, P=0.008; 3) MPADPCAT&gt;MD OR=0.450, P&lt;0.001; 4) VNADPCAT&gt;MD OR=0.408, p&lt;0.001; 5) ADPMEDIAN&gt;MD OR=0.394, p&lt;0.001). HDL-c (negative) was the only risk factor for atherosclerosis that correlated independently with smoking in all adjusted models, with leukocytes (positive) and creatinine (negative) showing correlation in 4 of the 5 models. Conclusion: Smoking is independently associated with lower PR and HDL-c levels.
Abstract 10388: Impact Of Right Ventricular Function On Cardiopulmonary Exercise Capacity In Mitral Regurgitation Patients Undergoing Transcatheter Mitral Valve Repair
Authors: Muhammed Gercek, Maria Ivannikova, Mustafa Gerçek, Arseniy Goncharov, Kai P Friedrichs, Volker Rudolph, Daniel Dumitrescu
Journal: Circulation (2022)

Background/Objectives: To investigate the role of right ventricular (RV) function on exercise capacity in patients undergoing transcatheter mitral valve repair (TMVR) we aimed to perform cardiopulmonary exercise testing (CPET) and to show a correlation between an improved RV function and maximal and submaximal exercise capacity. Methods: Constant work rate exercise time testing (CWRET) reflects submaximal/endurance exercise capacity, which is more likely to be relevant for daily life activities, and gives a more differentiated physiologic insight into the nature of exercise intolerance. Thus, 28 Patients with mitral regurgitation (MR) and symptomatic heart failure (NYHA≥II) underwent CPET by assessment of maximal oxygen uptake (peak VO 2 ) and submaximal exercise capacity (at 75% of maximal achieved work rate in the initial incremental exercise test) accompanied by echocardiography prior to TMVR and 3 months post-procedure. Results: Mean age of the patients was 75.0±8.7 years and 32.1% of them were female. One patient presented a reduction of MR &lt;2 grades. RV function (assessed with fractional area change, tricuspid annular plane systolic excursion, longitudinal strain of the RV free wall and S`) was at least moderately impaired in 25% of the patients. The submaximal exercise capacity of these patients was impaired, but did not significantly differ (416.4±359.6sec vs. 296.1 ±216.5sec; p=0.152) compared to patients without a deteriorated RV function. Three months after intervention, exercise time at 75% of maximal achieved work rate significantly improved (from 337.4±262.2sec to 517.4±393. sec p=0.006), reflecting a gain in submaximal exercise tolerance. peak VO 2 showed a positive trend, but no statistically significant difference (10.3±3.1ml/min/kg vs. 11.3±3.4ml/min/kg; p=0.056). RV function (at least 2 of 4 parameters) improved in 35.7% and these patients showed a significantly higher submaximal exercise time increasement (471.7±153.9sec vs. 82.7±47.0sec, p=0.003). Discussion/Conclusions: TMVR may have a beneficial effect on RV remodeling. Furthermore, submaximal exercise capacity is significantly increased, reflecting an improvement especially regarding daily life activities in MR patients and impaired RV function.
Abstract 10352: Characteristics of Survival in Older Patients With COVID-19: Insights From the American Heart Association COVID-19 Cardiovascular Disease Registry
Authors: Raymond Y Yeow, Michael P O'Leary, Akshay R Reddy, Neil S Kamdar, Salim S Hayek, James A De Lemos, Nadia R Sutton
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic has accounted for over 6.2 million deaths worldwide, disproportionally impacting older patients. Understanding the characteristics of older patients who were hospitalized with COVID-19 and survived to hospital discharge could provide insights into key factors that confer resilience in the setting of critical illness in this population. Methods: We leveraged the American Heart Association COVID-19 Cardiovascular Disease (AHA COVID-19 CVD) Registry to identify determinants of in-hospital survival in older patients (age ≥80 years) hospitalized for COVID-19 through April 2021. Patients ≥80 years old who survived to discharge (excluding if discharged alive to hospice or against medical advice) were included. A hierarchical multivariable logistic regression model with random intercept for each hospital was used to identify characteristics associated with survival. Results: The study included 4,426 patients ≥80 years of age. The median age was 85 years (IQR 82-89). 53% were women. 73% were White, 14% were Black, and 3% were Asian. The mortality rate in this subcohort was 28%. Characteristics associated with survival included female sex (adjusted OR 1.3; CI 1.1-1.6; p&lt; 0.001) and statin use prior to admission (adjusted OR 1.3; CI 1.1-1.6; p&lt; 0.001). Conversely, characteristics negatively associated with survival included mechanical ventilation (adjusted OR 0.17; CI 0.13-0.22; p&lt; 0.001), in-hospital shock (adjusted OR 0.33; CI 0.24-0.46; p&lt; 0.001), and sustained ventricular tachycardia (adjusted OR 0.28; CI 0.13-0.60; p&lt; 0.001). Conclusions: Female sex and statin use prior to admission were associated with improved survival in older patients hospitalized with COVID-19. The survival benefit associated with statin use and the increased susceptibility of older male patients to death from COVID-19 warrants further investigation.
Abstract 10874: Predictors of Prehospital Opiate Use in Patients With ST Elevation Myocardial Infarction: Results From a Nationwide Database
Authors: Dominika Szabo, András Szabó, Levente Magyar, Rita Szentgroti, Adam Kiraly, Bathó János Pál, Tibor Szegeczky, Tibor Kocsis, Istvan Ferenc Edes, Zoltan Ruzsa, David Becker, Bela Merkely, Andrea Szekely, Istvan Hizoh
Journal: Circulation (2022)

Introduction: Opiates are traditionally used in STEMI patients to relieve pain, decrease pulmonary congestion, and anxiety. Yet, according to in vitro measurements, they delay and diminish the effect of all currently used oral platelet P2Y12 receptor antagonists. To be able to draw causal conclusions on the potential effects of opiates on clinical outcomes using real-world registries, the bias in treatment allocation may be minimized by propensity score methods. Therefore, we constructed a simple model of prehospital opiate administration using the database of the National Ambulance Service. Methods: We analyzed data of 10,139 subjects who were diagnosed with STEMI within 24 hours from symptom onset between November 2018 and June 2021. Patients with unsuccessful out-of-hospital CPR were excluded. Opiates were applied in 3,992 cases (39.4%). Besides onset-to-door time and need for CPR due to OHCA, basic demographic data like age and sex were studied as candidate predictors using logistic regression. Non-linearity of the continuous predictors was assessed by restricted cubic splines. Relative importance of the predictors was characterized by the Akaike Information Criterion (AIC). Results: Overall model fit was good: likelihood ratio chi-square=610.40, d.f.=10, p&lt;0.0001. Opiate use was strongly associated with onset-to-door-time (p&lt;0.0001, AIC=333.83) and Wald testing for linearity suggested a non-linear relationship (p&lt;0.0001) with the highest odds at about 120 minutes. Similarly, it was also highly (p&lt;0.0001, AIC=193.78) and non-linearly (p&lt;0.0001) related to age with an inverted U-shaped curve. Moreover, it was negatively dependent on the need for CPR (p=0.0019, AIC=7.64) and unrelated to the sex of the patient (p=0.15, AIC=0.09). Conclusion: Our propensity score model may help to evaluate the role of opiate administration on clinical outcomes of STEMI patients and underscores the importance of non-linear modeling of continuous predictors.